The Cancer Risk among Physicians in Taiwan, a Population-Based Propensity Score Matched Cohort Study
Abstract
Background: The field of physician health is gaining increasing attention; however, most research and interventions have concentrated on factors such as job stress, mental health, and substance abuse. The risks of major cancers in physicians remain unclear. We used a propensity score-matched analysis to investigate the risk of cancer in physicians relative to the general population who had no healthcare-related professional background.
Methods: Data were obtained from the National Health Insurance system in Taiwan. The physician cohort contained 29,713 physicians, and each physician was propensity score-matched with a person from the general population.
Results: The physicians demonstrated a 0.90-fold lower risk of all-cancers (95% confidence interval [CI] = 0.83 – 0.96) when compared with the general population. Female physicians had a higher risk of cancer than male physicians (adjusted hazard ratio [HR] = 1.59; 95% CI = 1.28 – 1.96). Physicians had higher risks of prostate (HR = 1.26; 95% CI = 1.00 – 1.59) and thyroid cancers (HR = 3.16; 95% CI = 1.69 – 5.90) when compared with the general population.
Conclusion: Physicians have lower rates of overall cancer risk than the general population. Female physicians have higher cancer risks than male physicians. Male physicians have higher risks of thyroid and prostate cancer relative to the general population.
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24. Aschebrook-Kilfoy B, Ward MH, Della Valle CT, et al (2014). Occupation and thyroid cancer. Occup Environ Med, 71(5):366-380.
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26. Chen HF, Lee CH, Chang RE (2010). Workload of attending physicians at an academic center in Taiwan. J Chin Med Assoc, 73(8):425-30.
27. Magrini A, Pietroiusti A, Coppeta L, et al (2006). Shift work and autoimmune thyroid disorders. Int J Immunopathol Pharmacol, 19(4 Suppl):31-6.
28. Polyzos SA, Kita M, Efstathiadou Z, et al (2008). Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules. J Cancer Res Clin Oncol, 134(9):953-60.
29. Luo J, Sands M, Wactawski-Wende J, et al (2013). Sleep disturbance and incidence of thyroid cancer in postmenopausal women the Women's Health Initiative. Am J Epidemiol, 177(1):42-49.
30. Hsu YH, Kung PT, Wang YH, et al (2015). A comparison of the stages at which cancer is diagnosed in physicians and in the general population in Taiwan. CMAJ, 187(13):E412-E418.
2. Rosvold EO, Bjertness E (2001). Physicians who do not take sick leave: hazardous heroes? Scand J Public Health, 29(1):71-5.
3. Uallachain GN (2007). Attitudes towards self-health care: a survey of GP trainees. Ir Med J, 100(6):489-91.
4. Lee YS, Hsu CC, Weng SF, Lin HJ, et al (2015). Cancer Incidence in Physicians: A Taiwan National Population-based Cohort Study. Medicine (Baltimore), 94(47):e2079.
5. Lin SY, Lin CL, Hsu WH, et al (2013). A comparison of cancer incidence among physician specialists and the general population: a Taiwanese cohort study. J Occup Health, 55(3):158-166.
6. National Health Insurance Research Database. Available at: https://www.dovepress.com/taiwans-national-health-insurance-research-database-past-and-future-peer-reviewed-article-CLEP. Accessed December 12, 2017.
7. Liu CY HY, Chuang YL, Chen YJ, et al (2006). Incorporating development stratification of Taiwan townships into sampling design of large scale health interview survey. J Heal Manag, 4:1-22.
8. Deyo RA, Cherkin DC, Ciol MA (1992). Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol, 45(6):613-9.
9. Klein-Kremer A, Liphshitz I, Haklai Z, et al (2014). Cancer incidence among physicians in Israel. Isr Med Assoc J, 16(7):412-7.
10. Gold R, Michael YL, Whitlock EP, et al (2006). Race/ethnicity, socioeconomic status, and lifetime morbidity burden in the women's health initiative: a cross-sectional analysis. J Womens Health (Larchmt), 15(10):1161-73.
11. Cundiff JM, Uchino BN, Smith TW, et al (2015). Socioeconomic status and health: education and income are independent and joint predictors of ambulatory blood pressure. J Behav Med, 38(1):9-16.
12. Frank E (2004). STUDENTJAMA. Physician health and patient care. JAMA, 291(5):637.
13. Frank E, Brogan DJ, Mokdad AH, et al (1998). Health-related behaviors of women physicians vs other women in the United States. Arch Intern Med, 158(4):342-8.
14. Lin CM, Yang CH, Sung FC, et al (2008). Risks and causes of hospitalizations among physicians in Taiwan. Health Serv Res, 43(2):675-92.
15. Shen HN, Lu CL, Li CY (2014). Do physicians have lower risk of severe sepsis and associated mortality? A matched cohort study. Crit Care Med, 42(4):816-23.
16. Li CY, Sung FC (1999). A review of the healthy worker effect in occupational epidemiology. Occup Med (Lond), 49(4):225-9.
17. Kao LT, Chiu YL, Lin HC, et al (2016). Prevalence of chronic diseases among physicians in Taiwan: a population-based cross-sectional study. BMJ open, 6(3):e009954.
18. Jiang Y, Ong MK, Tong EK, et al (2007). Chinese physicians and their smoking knowledge, attitudes, and practices. Am J Prev Med, 33(1):15-22.
19. Potter GD, Skene DJ, Arendt J, et al (2016). Circadian Rhythm and Sleep Disruption: Causes, Metabolic Consequences, and Countermeasures. Endocr Rev, 37(6):584-608.
20. Kubo T, Ozasa K, Mikami K, et al (2006). Prospective cohort study of the risk of prostate cancer among rotating-shift workers: findings from the Japan collaborative cohort study. Am J Epidemiol, 164(6):549-55.
21. Conlon M, Lightfoot N, Kreiger N (2007). Rotating shift work and risk of prostate cancer. Epidemiology, 18(1):182-183.
22. Moretti RM, Marelli MM, Maggi R, et al (2000). Antiproliferative action of melatonin on human prostate cancer LNCaP cells. Oncol Rep, 7(2):347-51.
23. Kvale R, Auvinen A, Adami HO, et al (2007). Interpreting trends in prostate cancer incidence and mortality in the five Nordic countries. J Natl Cancer Inst, 99(24):1881-7.
24. Aschebrook-Kilfoy B, Ward MH, Della Valle CT, et al (2014). Occupation and thyroid cancer. Occup Environ Med, 71(5):366-380.
25. Zielinski JM, Garner MJ, Band PR, et al (2009). Health outcomes of low-dose ionizing radiation exposure among medical workers: a cohort study of the Canadian national dose registry of radiation workers. Int J Occup Med Environ Health, 22(2):149-56.
26. Chen HF, Lee CH, Chang RE (2010). Workload of attending physicians at an academic center in Taiwan. J Chin Med Assoc, 73(8):425-30.
27. Magrini A, Pietroiusti A, Coppeta L, et al (2006). Shift work and autoimmune thyroid disorders. Int J Immunopathol Pharmacol, 19(4 Suppl):31-6.
28. Polyzos SA, Kita M, Efstathiadou Z, et al (2008). Serum thyrotropin concentration as a biochemical predictor of thyroid malignancy in patients presenting with thyroid nodules. J Cancer Res Clin Oncol, 134(9):953-60.
29. Luo J, Sands M, Wactawski-Wende J, et al (2013). Sleep disturbance and incidence of thyroid cancer in postmenopausal women the Women's Health Initiative. Am J Epidemiol, 177(1):42-49.
30. Hsu YH, Kung PT, Wang YH, et al (2015). A comparison of the stages at which cancer is diagnosed in physicians and in the general population in Taiwan. CMAJ, 187(13):E412-E418.
| Files | ||
| Issue | Vol 50 No 2 (2021) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v50i2.5344 | |
| PMCID | PMC7956082 | |
| PMID | 33747993 | |
| Keywords | ||
| Cancer risk Cohort Study Gender Physicians Propensity score matching | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
YANG H-Y, CHEN C-R, LEE S-Y, TSAI W-C, HSU Y-H. The Cancer Risk among Physicians in Taiwan, a Population-Based Propensity Score Matched Cohort Study. Iran J Public Health. 2021;50(2):297-305.
